The Spice of Death: Sudden Cardiac Arrest After Novel Psychoactive Substance Exposure.

ABSTRACT: Novel psychoactive substances (NPSs), commonly referred to as "K2" or "spice," are a relatively new toxicology challenge for pediatricians. Adolescents often incorrectly believe that these drugs are safe and can be used without major adverse effects. Although recent legislation attempts to ensure that these drugs are not commercially available, many are able to be purchased online as "not fit for human consumption" or under various misnomers such "incense." In addition, there is a wide chemical variation among these substances, making regulation challenging. Standard urine drug screens test for tetrahydrocannabinol, which may not cross-react with synthetic substances, making NPS poisonings difficult to diagnose. We report a case of fatal cardiac arrest in a 16-year-old adolescent boy temporally associated with use of the NPS, 5F-ADB. The case illustrates the dangerous consequences that these unregulated substances pose to users, as well as the need for the consideration of comprehensive toxicological testing in patients with a history of substance use and sudden cardiac arrest, despite a negative drug screen.

Deaths from novel psychoactive substances in England, Wales and Northern Ireland: Evaluating the impact of the UK psychoactive substances act 2016.

BACKGROUND: 'Legal highs' began appearing in the UK in the mid-2000s. Whilst many of these substances were controlled under the 1971 Misuse of Drugs Act, novel compounds and new variants of controlled compounds were continuously being introduced to the recreational drug market. The Psychoactive Substances Act (PSA) was therefore implemented in 2016 as a blanket ban on all novel psychoactive substances (NPS). AIM: To evaluate the impact of the PSA on deaths following NPS use in England, Wales and Northern Ireland. METHODS: Cases reported to the National Programme on Substance Abuse Deaths where death had occurred 3 years pre- or post-implementation of the PSA were extracted. Cases with NPS detected at post-mortem were analysed and compared against cases non-NPS cases. RESULTS: 293 deaths with NPS detected were identified; 91 occurring before the PSA and 202 afterwards, indicating an 222.0% post-PSA increase. Contrastingly, non-NPS drug-related death case reporting increased by only 8.0%. Synthetic cannabinoid, anxiolytic/sedative and stimulant NPS were detected in the largest proportions of deaths pre-PSA; post-PSA stimulant NPS detections reduced whilst synthetic cannabinoid and anxiolytic/sedative detections increased.Post-PSA, average decedent age increased significantly (mean age pre-PSA 34.4 ± 10.8 vs post-PSA 38.3 ± 9.4), and they were significantly more likely to have been living in deprived areas (pre-PSA 50.0% vs post-PSA 65.9%). CONCLUSIONS: Reporting of deaths following NPS use has risen despite introduction of the PSA. Whilst deaths amongst younger individuals and those living in more affluent areas has reduced, additional approaches to prohibition are needed to curb their persistence in deprived demographics.

Fatal intoxication related to two new arylcyclohexylamine derivatives (2F-DCK and 3-MeO-PCE).

Continuous development and rapid turnover of drug market of new psychoactive substances (NPS) make it difficult to obtain up-to-date analytical methods for efficient detection of intoxication cases with new substances: no analytical data and no previously published concentration values in biological samples are indeed available. In this context, we aim to report the first fatal case involving two newly emerging arylcyclohexylamine derivatives (a group of dissociative ketamine-based substances): 2-fluoro-deschloroketamine (2F-DCK) and 3-methoxyeticyclidine (3-MeO-PCE). A 42-year-old man was found dead at his home with three plastic bags of "research chemicals" powders near him. Comprehensive screenings of drugs and toxic compounds as well as more selective assays (performed using NMR, HS-GC-FID, LC-MS/MS and LC-HRMS methods) allowed (1) to identify the three unknown powders, 2F-DCK, 3-MeO-PCE, and 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT, a hallucinogenic tryptamine-related NPS), with purity above 95%, and (2) to determine peripheral blood (1780, 90, and 52 µg/L), urine (6.1, 6.3, and 2.2 mg/L), bile (12, 3.5, and 1.7 mg/L), and vitreous humour (1500, 66 and 155 µg/L) concentrations of 2F-DCK, 3-MeO-PCE and 5-MeO-DMT, respectively. In addition, toxicological results also revealed recent use of cannabis, cocaine, and amphetamine by the victim, and hair analysis draw pathway of addiction (including experiments with various other NPS) for several months before death. This fatality was considered as the consequence of respiratory depression in a poly-drug user due to a "cocktail effect" of concurrent intakes of 2F-DCK (mainly), 3-MeO-PCE, 5-MeO-DMT, amphetamine, and cocaine. In addition, this case report provides analytical data that could support subsequent toxicological result interpretation in forensic cases involving such arylcyclohexylamine derivatives.

Abuse of nutmeg seeds: Detectable by means of liquid chromatography-mass spectrometry techniques?

Numerous case reports of intoxications with nutmeg seeds (Myristica fragrans, Houtt.) can be found in literature often following their abuse, as psychotropic effects were described after ingestions of large doses. The successful detection of the main ingredients of the nutmeg seeds essential oil elemicin, myristicin, and safrole, as well as their metabolites in human urine by gas chromatography coupled to mass spectrometry (GC-MS) was already described. The aim of this study was to investigate the detectability of the main ingredients of nutmeg seeds and their metabolites in human blood and urine samples using liquid chromatography coupled to linear ion trap mass spectrometry (LC-LIT-MSn ) and liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS/MS) after nutmeg seed abuse. Sample material of three individuals was retrospectively investigated after a systematic screening approach indicated an intoxication with nutmeg seeds as a likely cause of symptoms. Metabolic patterns in plasma and urine using GC-MS were comparable with those described in earlier publications. Investigations using hyphenated liquid chromatography techniques lead to the detection of myristicin and safrole, as well as further metabolites not described using GC-MS and revealed sulfation as an additional Phase II metabolic pathway. These results might help to detect or confirm future intoxications with nutmeg seeds by using LC-MS techniques.

Isotonitazene: Fatal intoxication in three cases involving this unreported novel psychoactive substance in Switzerland.

The paper describes the first three deaths reported in Europe involved in isotonitazene consumption, a potent benzimidazole derivate opioid consumed in the recreational drug scene. Isotonitazene powder and purity determination was performed on the sample collected in the first death scene by NMR, HRMS, GC-FTIR, ATR-FTIR and GC-MS. Isotonitazene purity was determined by GC-MS analysis and proton NMR, and was defined to be above 95 % and 98 %, respectively. Quantification of isotonitazene in biological samples was performed using a targeted analysis based on SPE extraction and ultra-high performance liquid chromatography tandem mass spectrometry. The isotonitazene median concentration in femoral whole blood was 1.20ng/mL. Isotonitazene concentration in hair was similar or even lower compared to that seen in fentanyl abusers. Isotonitazene distribution in tissues converges in the brain, lungs and heart, respectively. Surprisingly, isotonitazene concentration in liver is the lowest measured for all tissues and fluids analyzed. Based on circumstantial evidence, autopsy findings and the results of the toxicological analysis, the medical examiner concluded that the cause of all three deaths was an acute intoxication with isotonitazene. Since isotonitazene toxic concentration levels are very low, the consumption of this new psychoactive drug is a real hazard for human health.

Fatal intoxication involving 4-methylpentedrone (4-MPD) in a context of chemsex.

4-methylpentedrone (4-MPD) is a new psychoactive substance (NPS) belonging to the cathinone class. We report an original case of death mainly involving 4-MPD, along with cocaine, sildenafil, bromazepam and nevirapine. The investigation data and the autopsy findings indicated fatal intoxication in a chemsex context (drug use during sex). 4-MPD concentrations were determined in peripheral blood (1285 ng/mL), cardiac blood (1128 ng/mL), urine (>10,000 ng/mL), bile (1187 ng/mL) and vitreous humor (734 and 875 ng/mL in left and right samples, respectively) by gas chromatography (GC) coupled to tandem mass spectrometry. 4-MPD metabolites were explored by GC coupled to high resolution mass spectrometry. Due to the paucity of data concerning 4-MPD, its use and effects were gathered from online user testimonies. This case illustrates the toxicity of this infrequent pentedrone derivate and confirms the significant overdose risk associated with chemsex.

Perfil toxicológico dos suicídios no Rio Grande do Sul, Brasil, 2017 a 2019 / Perfil toxicológico de los casos de suicidio en Rio Grande do Sul (Brasil), 2017-2019 / Toxicology of suicide cases in the state of Rio Grande do Sul, Brazil, 2017 to 2019

RESUMO Objetivo. Descrever o perfil toxicológico de todas as vítimas de suicídio no Rio Grande do Sul, Brasil, de 2017 a 2019. Métodos. Neste estudo descritivo e transversal, foram consultados todos os laudos periciais e as ocorrências policiais relacionados aos óbitos por suicídio no estado. Foram realizadas análises de correspondência múltipla e construídos modelos independentes de regressão logística, tendo como variáveis dependentes o etanol, os ansiolíticos, os antidepressivos, as substâncias ilícitas e os agentes tóxicos não medicamentosos. Resultados. Foram realizados 2 978 exames de alcoolemia, com resultado positivo em 28,5%. A chance de resultados positivos para alcoolemia foi 0,5 (IC95%: 1,1 a 2,2) vez maior para suicídio durante a noite, 1,0 (IC95%: 1,4 a 2,9) vez maior para suicídio aos finais de semana e 0,9 (IC95%: 1,3 a 2,7) vez maior na presença de antecedentes criminais. A pesquisa de psicotrópicos (2 900 amostras) detectou algum medicamento em 30,4%. Os ansiolíticos foram a classe mais frequente, com chance 1,5 (IC95%: 1,6 a 4,1) vez maior em mulheres e 0,8 (IC95%: 1,2 a 2,7) vez maior para suicídios ocorridos no outono-inverno. As substâncias ilícitas (n = 338) tiveram chance 4,1 (IC95%: 1,9 a 14,4) vezes maior de detecção na macrorregião de Pelotas em relação à de Passo Fundo e 1,2 (IC95%: 1,3 a 3,6) vez maior em pessoas com resultados positivos para etanol. Não houve diferença significativa entre adolescentes e adultos. Conclusões. Embora sem evidência de causalidade, os resultados mostram um vínculo entre o suicídio e diversos psicoativos. Os médicos legistas devem ser orientados quanto à necessidade de realização de exames toxicológicos em todos os casos de suicídio.

ABSTRACT Objective. To describe the toxicology of suicide cases recorded in the state of Rio Grande do Sul, Brazil, from 2017 to 2019. Method. The present descriptive, cross-sectional study examined all the medico-legal reports and police records related to suicide deaths in the state. Multiple correspondence analyses were performed along with independent logistic regression models having ethanol, anxiolytic and antidepressant drugs, illicit drugs, and non-medical substances as dependent variables. Results. Ethanol was investigated in 2 978 samples, with positive results in 28.5%. The odds of a positive ethanol finding were 0.5 time higher (95%CI: 1.1; 2.2) for suicides occurring at night, 1.0 (95%CI: 1.4; 2.9) time higher for suicides occurring on weekends, and 0.9 (95%CI: 1.3; 2.7) time higher in individuals with a prior criminal record. Investigation of psychotropic drugs (2 900 samples) was positive in 30.4% samples. Anxiolytics were the most common medication detected, with 1.5 (95%CI: 1.6; 4.1) time higher odds of occurrence in women and 0.8 time higher odds (95%CI: 1.2; 2.7) for suicides occurring in the fall-winter. The odds of detecting illicit drugs (n = 338) were 4.1 times higher (95%CI: 1.9; 14.4) in the regions of Pelotas (south of the state) vs. Passo Fundo (north), and 1.2 (95%CI: 1.3; 3.6) time higher in cases with positive ethanol results, without significant difference between adolescents and adults. Conclusions. Despite the lack of evidence on causality, the present results support a link between suicide and several psychoactive drugs. Medico-legal experts should be guided regarding the need to perform toxicological tests in all suicide cases.

RESUMEN Objetivo. Describir el perfil toxicológico de todas las víctimas de suicidio en Rio Grande do Sul desde el 2017 hasta el 2019. Métodos. En este estudio descriptivo y transversal se consultaron todos los informes periciales y policiales sobre las muertes por suicidio en el estado. Se realizaron análisis de correspondencia múltiple y se crearon modelos independientes de regresión logística, con empleo de etanol, productos ansiolíticos y antidepresivos, sustancias ilícitas y agentes tóxicos no medicamentosos como variables dependientes. Resultados. Se realizaron 2 978 exámenes de alcoholemia, con resultado positivo en un 28,5%. La probabilidad de obtener resultados positivos para alcoholemia aumentó 0,5 (IC95%: 1,1-2,2) en casos de suicidio durante la noche, 1,0 (IC95%: 1,4-2,9) en casos de suicidio en los fines de semana y 0,9 (IC95%: 1,3-2,7) cuando había antecedentes penales. En la investigación de productos psicotrópicos (2 900 muestras) se detectó algún medicamento en un 30,4%. Los ansiolíticos fueron la clase detectada con más frecuencia, con un aumento de la probabilidad de 1,5 (IC95%: 1,6-4,1) en las mujeres y de 0,8 (IC95%: 1,2-2,7) en casos de suicidio durante el otoño y el invierno. El aumento de la probabilidad de detección de sustancias ilícitas (n = 338) fue de 4,1 (IC95%: 1,9-14,4) en la macrorregión de Pelotas en comparación con la de Passo Fundo y de 1,2 (IC95%: 1,3-3,6) en personas con resultados positivos en la prueba de detección de etanol, sin que hubiera ninguna diferencia significativa entre adolescentes y adultos. Conclusiones. Aun sin haberse comprobado la causalidad, los resultados muestran que existe un vínculo entre el suicidio y diversos productos psicoactivos. Es preciso orientar a los médicos legistas con respecto a la necesidad de realizar exámenes toxicológicos en todos los casos de suicidio.

Flakka: New Dangerous Synthetic Cathinone on the Drug Scene.

New psychoactive substances are being used as drugs and appear to be quite popular nowadays. Thanks to their specific properties, these drugs create inimitable experiences for intoxicated people. Synthetic cathinones are the most common compounds in these new drugs. Among them, α-pyrrolidopentadione (α-PVP), or "Flakka" (street name), is one of the most famous cathinone-designed drugs. Similar to other synthetic cathinone drugs, α-PVP can effectively inhibit norepinephrine and dopamine transmitters. The adverse reactions of α-PVP mainly include mania, tachycardia, and hallucinations. An increasing number of people are being admitted to emergency wards due to the consequences of their use. This work mainly summarizes the history, synthesis, pharmacology, toxicology, structure-activity relationship, metabolism, clinical process and health risks, poisoning and death, forensic toxicology, and legal status of α-PVP. We hope this review will help bring more attention to the exploration of this substance in order to raise awareness of its negative impacts on humans.

Intoxication cases associated with the novel designer drug 3',4'-methylenedioxy-α-pyrrolidinohexanophenone and studies on its human metabolism using high-resolution mass spectrometry.

Among the increasing number of new psychoactive substances, 3',4'-methylenedioxy-α-pyrrolidinohexanophenone (MDPHP) belongs to the group of synthetic cathinones, which are the derivatives of the naturally occurring compound cathinone, the main psychoactive ingredient in the khat plant. Currently, only limited data are available for MDPHP, and no information is available on its human metabolism. We describe the toxicological investigation of nine cases associated with the use of MDPHP during the period February-June 2019. Serum MDPHP concentrations showed a high variability ranging from 3.3 to 140 ng/mL (mean 30.3 ng/mL and median 16 ng/mL). Intoxication symptoms of the described cases could not be explained by the abuse of MDPHP alone because in all cases the co-consumption of other psychotropic drugs with frequent occurrence of opiates and benzodiazepines could be verified. Therefore, the patients showed different clinical symptoms, including aggressive behaviour, delayed physical response, loss of consciousness and coma. Liquid chromatography-high-resolution mass spectrometry was successfully used to investigate the human in vivo metabolism of MDPHP using authentic human urine samples. The metabolism data for MDPHP were further substantiated by the analysis of human urine using gas chromatography-mass spectrometry (GC-MS, a widely used systematic toxicological analysis method appropriate for the toxicological detection of MDPHP intake), which revealed the presence of seven phase I metabolites and three phase II metabolites as glucuronides. GC-MS spectral data for MDPHP and metabolites are provided. The identified metabolite pattern corroborates the principal metabolic pathways of α-pyrrolidinophenones in humans.

Drug trends and harm related to new psychoactive substances (NPS) in Sweden from 2010 to 2016: Experiences from the STRIDA project.

BACKGROUND: In the past decade, hundreds of new psychoactive substances (NPS) have been introduced as unclassified alternatives to the illicit drugs. The NPS represent a growing health concern by causing adverse effects and deaths but are usually undetectable by conventional drug tests. This report summarizes results and experiences from analytically confirmed drug-related acute intoxications in emergency departments (ED) and intensive care units (ICU) enrolled in the Swedish STRIDA project on NPS in 2010-2016. METHODS AND FINDINGS: ED/ICU intoxications suspected to involve NPS were enrolled in the project, after initial contact with the Poisons Information Centre (PIC). Serum/plasma and urine samples, and sometimes drug products, were subjected to a comprehensive toxicological investigation, and the PIC retrieved information on associated clinical symptoms and treatment. Between January 2010-February 2016, 2626 cases were enrolled. The patients were aged 8-71 (mean 27, median 24) years and 74% were men. Most biological samples (81%) tested positive for one, or more (70%), psychoactive drugs, including 159 NPS, other novel or uncommon substances, classical recreational and illicit drugs, and prescription medications. When first detected, most NPS or other novel substances (75%) were not banned in Sweden, but they usually disappeared upon classification, which however often took a year or longer. Some NPS were found to be especially harmful and even fatal. CONCLUSIONS: The STRIDA project provided a good overview of the current drug situation in Sweden and demonstrated a widespread use and rapid turnover of many different psychoactive substances. The accomplishment of the project can be attributed to several key factors (close collaboration between the PIC and laboratory to identify suspected poisonings, free analysis, continuous updating of analytical methods, evaluation of adverse effects, and sharing information) that are useful for future activities addressing the NPS problem. The results also illustrated how drug regulations can drive the NPS market.

The Role and Promise of Artificial Intelligence in Medical Toxicology.

Artificial intelligence (AI) refers to machines or software that process information and interact with the world as understanding beings. Examples of AI in medicine include the automated reading of chest X-rays and the detection of heart dysrhythmias from wearables. A key promise of AI is its potential to apply logical reasoning at the scale of data too vast for the human mind to comprehend. This scaling up of logical reasoning may allow clinicians to bring the entire breadth of current medical knowledge to bear on each patient in real time. It may also unearth otherwise unreachable knowledge in the attempt to integrate knowledge and research across disciplines. In this review, we discuss two complementary aspects of artificial intelligence: deep learning and knowledge representation. Deep learning recognizes and predicts patterns. Knowledge representation structures and interprets those patterns or predictions. We frame this review around how deep learning and knowledge representation might expand the reach of Poison Control Centers and enhance syndromic surveillance from social media.

A comprehensive analysis of attempted and fatal suicide cases involving frequently used psychotropic medications.

OBJECTIVES: Self-poisoning is the most common suicide method in non-lethal suicide attempts and the third most frequent in fatal suicides. Psychoactive drugs are often used for intentional self-poisoning. While poisons centre data typically focus on survived suicide attempts and underrepresent fatal self-poisoning, medical examiner reports give insight into suicide deaths. To close this gap, we combined and compared data sets from both sources, assessing the mortality of psychotropic drugs used for self-poisoning. METHODS: Anonymized cases of self-poisoning with suicidal intention from 2000 to 2010 were extracted from the national poisons centre case database and compared with cases of suicide documented in the project "Suicides, a national survey". All cases with single substance exposure to a psychoactive drug (antidepressants, mood stabilizers, antipsychotics, sedatives) were included in the analyses. Opioids, over-the-counter- and illicit- drugs were excluded from the analysis. A mortality index was calculated by the ratio of the number of suicides and the sum of all (lethal and non-lethal) suicide attempts. RESULTS: Tricyclics had a higher mortality rate than other antidepressants. Among the sedatives, zolpidem was found to have a higher mortality index compared to benzodiazepines. Clozapine and levomepromazine were found to be the most lethal antipsychotics. Non-lethal suicide cases with single substance exposure (n = 4697) diminished as age increased, while the rate of suicide cases (n = 165) was higher in elderly subjects (>65 years of age, p < 0.001). CONCLUSION: In summary, our findings confirm previous study results on the relative toxicity of distinct classes of psychotropic drugs. In this comprehensive analysis of a national cohort lorazepam had a lower mortality rate compared to other sedatives.

Severe Toxicity to the New Psychoactive Substances 3-Hydroxyphencyclidine and N-Ethylhexedrone: an Analytically Confirmed Case Report.

INTRODUCTION: 3-Hydroxyphencyclidine (3-HO-PCP) is a new psychoactive substance (NPS) and a hydroxy derivative of phencyclidine (PCP), and N-ethylhexedrone (Hexen) is a synthetic cathinone. We describe an analytically confirmed case of acute toxicity related to the use of both 3-hydroxyphencyclidine and N-ethylhexedrone. CASE REPORT: A 56-year-old male was brought to the Emergency Department by ambulance with hyperthermia (39.9 °C), sinus tachycardia (150 beats per minute), reduced consciousness, ocular clonus, and vertical nystagmus. He was treated with cooled intravenous (IV) fluids and IV benzodiazepines. Following 1 hour of treatment, his temperature fell to 37.7 °C, he developed rhabdomyolysis (creatine kinase peaked at 5999 IU (normal range < 229 IU)): he was managed with supportive measures and was discharged after 25 hours. The patient admitted regular use of Hexen and recent use of 3-HO-PCP. Analysis of urine and serum identified 3-hydroxyphencyclidine and metabolites, N-ethylhexedrone and metabolites, and clephedrone and metabolites. DISCUSSION: This is a case of analytically confirmed toxicity to 3-HO-PCP and N-ethylhexedrone. The acute toxicity reported in this patient is consistent with the use of 3-HO-PCP, but there were sympathomimetic and serotonergic features potentially consistent with the cathinone N-ethylhexedrone. The description of the acute toxicity of NPS, such as these, is vital to aid medical toxicologists and emergency medicine physicians treating patients who use them.

Femoral blood concentrations of flualprazolam in 33 postmortem cases.

Flualprazolam is a novel designer benzodiazepine, structurally related to alprazolam, flubromazolam and triazolam. In the last couple of years, it has been frequently detected in seizures and in forensic cases in Sweden and Finland. However, there is a lack of published blood concentrations for the drug, which presents difficulties when assessing its relevance for the cause of death. A quantitative method for the determination of flualprazolam in post-mortem blood was developed and validated, and subsequently used to analyse samples from 33 deaths previously screened as testing positive for flualprazolam in Sweden and Finland. Most of the cases in the study were accidental deaths (61 %) or suicides (18 %). The median (range) flualprazolam concentration was 18.0 (3.0-68) ng/g. The majority of the deceased were male (82 %) and the median age was 30 years. The median age in the Swedish cases was significantly higher (35 years) than in the Finnish cases (23 years) (p< 0.05). Poly-drug use and particularly the concomitant use of flualprazolam and opioids were very common in the study population. Most of the cases that were positive for flualprazolam were fatal poisonings by a drug (N=23), and in 13 cases, flualprazolam was implicated in the cause of death. Combining the resources of two countries in which all post-mortem toxicology is centralised provided a more comprehensive insight into the toxicology of flualprazolam. Research on novel psychoactive substances, such as flualprazolam, is required in order to be able to provide scientific evidence on the risks of these new substances for drug administration and potential users.

[Diagnostics and treatment of selected clinically relevant, acute drug intoxications]. / Diagnostik und Behandlung ausgesuchter akuter Arzneimittelvergiftungen mit hoher klinischer Relevanz.

Acute drug poisoning due to accidental or self-damaging overdoses is responsible for 5-10% of emergency medical interventions in Germany. The treatment of asymptomatic to life-threatening courses requires extensive expertise. On the basis of a selective literature search, this article gives an overview of selected clinically relevant, acute drug poisonings with regard to epidemiology, symptomatology, diagnostics, and therapy.Intoxications with psychotropic drugs are the most common drug intoxications. Poisoning with tricyclic antidepressants causes anticholinergic, central nervous, and cardiovascular symptoms. Less toxic are selective serotonin reuptake inhibitors (SSRIs); the intoxication may be characterized by serotonin syndrome. Malignant neuroleptic syndrome is a severe complication of neuroleptic poisoning.Poisoning with analgesics is clinically relevant due to its high availability. For paracetamol poisoning, intravenous acetylcysteine is available as an antidote. Hemodialysis may be indicated for severe salicylate intoxication. Poisoning with nonsteroidal anti-inflammatory drugs is usually only associated with mild signs of intoxication.Poisoning with cardiac drugs (ß-blockers and calcium antagonists) can cause life-threatening cardiovascular events. In addition to symptomatic therapy, insulin glucose therapy also plays an important role.The majority of acute drug poisonings can be treated adequately by symptomatic and partly intensive care therapy - if necessary with the application of primary and secondary toxin elimination. Depending on the severity of the intoxication, pharmacology-specific therapy must be initiated.

[Overdose deaths from narcotic drugs and psychotropic substances in Russia (an analysis of materials for the period 2003 to 2018)]. / Smertel'nye otravleniia narkoticheskimi sredstvami i psikhotropnymi veshchestvami v Rossii (po materialam 2003-2018 gg.).

The purpose of the work is to study the prevalence of overdose deaths from narcotic drugs and psychotropic substances in Russia, as determined by forensic autopsies, for the period 2003 to 2018. For the study, medical statistics were processed, the percentages for each indication were calculated, and the changes in the percentages for different types of overdose deaths were noted. It was established in forensic autopsies for the period under study, that the percentage of narcotic overdose deaths ranged from 4.2% to 16.6% of the total number of poisonings, while the percentage of overdose deaths from psychotropic substances ranged from 0.7% to 1.3%.

[The use of biochemical characteristics of cadaveric blood in the forensic diagnosis of lethal poisoning]. / Ispol'zovanie nekotorykh sudebno-biokhimicheskikh pokazatelei trupnoi krovi pri diagnostike letal'nykh otravlenii.

The purpose of the work is the development of mathematical models in the forensic diagnosis of poisonings by the main groups of toxicologically important substances, on the basis of biochemical characteristics of blood. The most informative forensic and biochemical indicators of cadaveric blood used to detect lethal poisoning are the urea content, total protein content, and the ratio of urea to creatinine. Mathematical models of poisoning can be used to diagnose poisoning with narcotic drugs, psychotropic substances and substitutes of ethyl alcohol.

[Analysis of fatal cases of psychoactive drug overdoses in the Crimean Republic between 1993-2017]. / Analiz smertel'nykh otravlenii psikhoaktivnymi veshchestvami v Respublike Krym za 1993-2017 gg.

An analysis of fatal drug overdoses in the population of the Crimean Republic between 1993-2017 was conducted. The epidemiological characteristics of these drug overdoses were determined. Deaths from drug overdoses occurs mainly in male population during the most active years of drug use (21-30 years). The most frequent cause of death is opioid drug overdose and combined alcohol-opioid intoxication.

Rise in mortality involving poisoning by medicaments other than narcotics, including poisoning by psychotropic drugs in different age/racial groups in the US.

BACKGROUND: Increase in mortality involving poisoning, particularly by narcotics, is known to have been one of the factors that affected life expectancy in the US during the last two decades, especially for white Americans and Native Americans. However, the contribution of medicaments other than narcotics to mortality in different racial/age groups is less studied. METHODS: We regressed annual rates of mortality involving poisoning by medicaments but not narcotics/psychodysleptics (ICD-10 codes T36-39.xx or T41-50.8 but not T40.xx present as either underlying or contributing causes of death), as well as annual rates of mortality for certain subcategories of the above, including mortality involving poisoning by psychotropic drugs but not narcotics/psychodysleptics (ICD-10 codes T43.xx but not T40.xx present as either underlying or contributing causes of death) in different age/racial groups for both the 2000-2011 period and the 2011-2017 period against calendar year. RESULTS: Annual numbers of deaths involving poisoning by medicaments but not narcotics/psychodysleptics grew from 4,332 between 2000-2001 to 11,401 between 2016-2017, with the growth in the rates of those deaths being higher for the 2011-2017 period compared to the 2000-2011 period. The largest increases in the rates of mortality involving poisoning by medicaments but not narcotics/psychodysleptics were in non-elderly Non-Hispanic Native Americans, followed by Non-Hispanic whites. Most of those increases came from increases in the rates of mortality involving poisoning by psychotropic medications; the latter rates grew for the period of 2015-2017 vs. 2000-2002 by factors ranging from 2.75 for ages 35-44y to 5.37 for ages 55-64y. CONCLUSIONS: There were major increases in mortality involving poisoning by non-narcotic, particularly psychotropic medicaments, especially in non-elderly non-Hispanic whites and Native Americans. Our results support the need for a comprehensive evaluation of the effect of psychotropic medications on health-related outcomes, including mortality for causes other than poisoning, and the impact of medication misuse.